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Report Produced: 12/13/2025 04:31 AM

Report Question ID Question Discussion Answer Year
20110121 MP/H Rules/Histology--Esophagus: Will the AJCC TNM 7 having separate stage groupings for squamous cell carcinoma and adenocarcinoma result in coding histology for a tumor of mixed squamous cell carcinoma and adenocarcinoma to squamous cell carcinoma because it has the poorer prognosis? See Discussion.

Per the CS Esophageal Schema, Note 4, there are now separate stage groupings for squamous cell carcinoma and adenocarcinoma. Should a tumor of mixed histopathologic type be classified as a squamous cell carcinoma?

Do NOT use the Collaborative Stage Manual to determine the histology code. For CS STAGING purposes only, coding should be based on the squamous cell carcinoma component of this tumor.

The Multiple Primary and Histology Coding Rules Manual is the correct source for coding histology. For cases diagnosed 2007 or later, the following steps are used to determine the histology code:

Open the Multiple Primary and Histology Coding Rules manual. For an esophagus primary, use the Other Sites Histo rules to determine the histology code because esophagus does not have site specific rules.

Start at Rule H8 because this is an invasive histology (assuming this is a single tumor). which states that one should code the appropriate combination/mixed code from Table 2 when there are multiple specific histologies.

Find Other Sites for Table 2 under the Terms & Definitions section of manual.

Locate the appropriate mixed code for squamous cell carcinoma and adenocarcinoma in column 1. Per column 3, the correct histology is adenosquamous carcinoma. Per column 4, the correct histology is 8560/3.

2011
20180037

Date of Diagnosis--Colon: If a patient has a positive Cologuard test, is the date of diagnosis the date of the cologuard test or the date of the biopsy?

Do not use the date of a positive Cologuard test as the date of diagnosis.

 2018
20250019

SEER Manual/Tumor Size Summary--Breast: Can the size of a non-mass enhancement (NME) be used if it represents the largest size within the appropriate time frame to code tumor size summary when neoadjuvant therapy is administered? Clinical and pathologic tumor sizes are no longer collected for 2024 and 2025 cases. See Discussion.

In the SEER Program Coding and Staging Manual 2023, under clinical tumor size (page 115, item #12), it states: “For breast tumors, clinical size may be recorded based on the size of a non-mass enhancement (NME). NME is defined as an enhancing abnormality that is not associated with the three-dimensional volume of a mass, shape, and outlining, and it is separate from Background Parenchymal Enhancement (BPE).” This guidance does not appear to have been carried forward into the Tumor Size Summary coding instructions.

Do not use the NME size from magnetic resonance imaging (MRI) to code tumor size when both tumor size and NME size are stated or if NME is the only size available. The size of the solid tumor mass takes priority over the size of the NME when provided separately and the NME is larger.

The American College of Radiology, Breast Imaging Reporting and Data System (BI-RADS) defines NME as an area of enhancement on MRI that does not belong to a 3D mass or have distinct features of a mass. It is a separate descriptor from size that includes modifiers describing enhancement patterns with a specific MRI pattern.

2025
20200053

Solid Tumor Rules (2018)/Multiple primaries--Bladder. Would the metastatic diagnosis indicate a new primary? If the metastatic diagnosis indicates a new primary, would the primary site be C688 and date of diagnosis 11/14/18? See Discussion.

7/8/16 Urinary bladder, biopsy: Non-invasive low grade papillary urothelial carcinoma. Muscularis propria (detrusor muscle) is not identified.

9/2/16 Urinary bladder, bladder tumor, transurethral resection: High grade papillary urothelial carcinoma. No definite invasion identified. Muscularis propria (detrusor muscle) is identified and not involved by tumor.

1/7/17 A\S\Bladder: Noninvasive low grade papillary urothelial carcinoma. Granulomatous cystitis, consistent with BCG (Bacillus Calmette-Guerin) treatment. Lamina propria is not involved with tumor. Detrusor muscle is not identified.

4/4/17 Dome: Papillary urothelial carcinoma, low grade. No evidence of invasion. Muscularis propria is not present.

Patient is clearly followed for at least a year but no further information until 19 months later, 11/14/18, when biopsy of lung indicates metastatic disease.

11/14/18 Lung, right lower lobe, mass, biopsy: Metastatic urothelial carcinoma. Immunohistochemical analysis results (CK7 positive, CK20 focally positive, P63 positive, GATA3 positive, TTF1 negative and NAPSIN-A negative) support the diagnosis

Do not use the solid tumor rules to assess the 2018 diagnosis. See Note 1 on page 20 of the Urinary Sites Solid Tumor Rules, https://seer.cancer.gov/tools/solidtumor/Urinary_STM.pdf

The 2018 diagnosis proves that this patient had invasive bladder cancer. Change the behavior on the abstract to /3 and use text fields to record the details.

 2020
20110048 First course treatment--Heme & Lymphoid Neoplasms: How is a "donor lymphocyte infusion" that is used in the treatment of CLL coded?

Donor lymphocyte infusion (DLI) is coded as immunotherapy. The lymphocytes are donated by the same person who donated the original stem cell transplant. The lymphocyte infusion creates an immune response in which the T-cells are activated to attack the cancer cells.

See "Treatments" for CLL/SLL (9823/3)

 2011
20210076

Reportability/Brain and CNS:  Is a 2021 case of ecchordosis physaliphora (lesion within the prepontine cistern) on brain MRI reportable?

Ecchordosis physaliphora is not reportable.

 2021
20051077 First Course Treatment--Unknown & ill-defined site: We have a case with an unknown primary site and the patient had chemoembolization into the hepatic artery. We don't know how to code this treatment. See Discussion. We were told to code as surgery (10) and chemo (01). However an unknown primary automatically gets a (98) surgery code & the chemo is coded (01) but we can't code as systemic therapy. This is an edit. Chemo coded but no date of systemic therapy.

Effective for cases coded prior to the change in policy made on January 9, 2008, code chemoembolization of a metastatic site as 1 [nonprimary surgical procedure performed] in Surgical Procedure of Other Site.

Surgery of Primary Site code 98 is assigned to all cases with an unknown primary.

In the case of a liver primary, it would be coded 10 [local tumor destruction, NOS] in Surgical Procedure of Primary Site.

 2005
20190094

Reportability/Heme & Lymphoid Neoplasms--Skin: Is elephantiasis nostras verrucosa (ENV) reportable as a lymphoma? See Discussion.

The autopsy report indicated a diagnosis of: Skin: Hyperkeratosis and pseudoepitheliomatous hyperplasia as well as reactive angioendotheliomatosis indicating Elephantiasis Nostras Verrucosa.

Elephantiasis nostras verrucosa (ENV) is not reportable. ENV is a rare form of chronic lymphedema caused by any number of conditions including neoplasms, trauma, radiation treatment, congestive heart failure, obesity, hypothyroidism, chronic venous stasis, and parasitic infection.

 2019
20210034

Reportability/Histology--Endometrium: Is endometrial hyperplasia with atypia equivalent to atypical hyperplasia of the endometrium (8380/2) and thus reportable?

Endometrial hyperplasia with atypia is equivalent to atypical hyperplasia of the endometrium (8380/2) and thus reportable for cases diagnosed 2021 and later. Our expert pathologist consultant confirmed this for us.

 2021
20230035

Update to Current Manual/2018 EOD Manual/EOD Primary Tumor--Bladder: According to the American Joint Commission on Cancer (AJCC), a transurethral resection of the bladder (TURB) cannot make a distinction between involvement of the superficial muscle-inner half (Stage T2a) and the deep muscle-outer half (Stage T2b). Is this same criteria applied to Extent of Disease (EOD)?

EOD follows AJCC criteria in this situation and we have confirmed with AJCC that Stage T2a (superficial muscle) and Stage T2b (deep muscle) cannot be assigned when only a TURB is done.

For EOD Primary Tumor, Bladder, codes 200, 250, 300, 350, can only be used when

  • Cystectomy is performed
  • Muscularis propria is involved, AND
  • Pathology report states superficial muscle (200, 250) or deep muscle (300, 350) is involved

If a TURB is done and there is mention of the muscularis propria invasion (superficial muscle or deep muscle), use EOD codes 370 or 400. If a TURB is done and the pathology report states superficial or deep muscle, ignore and coded as “invasion of muscularis propria, NOS” (EOD codes 370 or 400).

Instructions and code descriptions for EOD Primary Tumor have been updated to indicate this. These updated instructions and code descriptions will be available when SEER*RSA is updated for 2024, Version 3.1 (Sept/Oct 2023). These updates are included here for reference and can be applied for cases diagnosed 2018+.

 2023